HomeMy WebLinkAboutMortgage_Jobe STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'n` r'(- FOR DEDUCTION FROM ASSESSED VALUATION
r°• '• State Form 43709(R13/10-15)
Presorted by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. with:laic Filing Dates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sg(�L
Must be filed orpostmarIced with the County Auditor or County Recorder of the county where t pro is +lit <•unty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobde/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coon
where the property is located during the twelve(12)months before March 31 of each year the deducticO@To490 2 1G
See reverse side for additional instructions and qualifications.
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Taxing District number description IBSO .Kpeit'1blitieAUU $ 1
aE- (8'3to . 40a —D0 r3co 1—O0`� 02D1 Le
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessmey(�currea r date of application legal or equitable owner?
((TTSj ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is efferent than that of applicant,indicate below Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Or( P
Address of mortgagee or contract seller(number andJ reet city,state,and ZIP code)
•Name of assignee or other owner or holder of mortgage -— (� �� ,, n— Tr —
—Address of assignee(number and street city,state,and ZIP code) /�,-) 1\ 1h l�(/►.-(7-'
Does applicant own property in any If yes,what county? What Taxing District pi_ N�'. (� \ _ ," It nt of deducdm
other county rl-C)2
in Indiana? ❑Yes ❑No p ' i44 8
A n is not entitled to this deduction unless the arson has a balance on the `� din the county
recorder's office(including any home equity line of credit that is recorded in the c I ___......w....
COUNTY A
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owr I contract buyer of the aforementioned property on date application is filed.
e lame e)
xig te ) bate(month,day,year)
rlo taddressof app4t(nu and span,city state, —Z vi 4 -1 kr
Person authorized by duly executed Power of Attorney or by IC a-1.11.1-122-00.7_` Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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